Predictive power of serum NSE and OHCA score regarding 6-month neurologic outcome after out-of-hospital ventricular fibrillation and therapeutic hypothermia.
OBJECTIVE
To determine the predictive power of the out-of-hospital cardiac arrest (OHCA) score and serum neuron-specific enolase (NSE) in patients resuscitated from ventricular fibrillation treated with therapeutic hypothermia (TH) and glucose control.


METHODS
An analysis of prospectively collected data of 90 TH patients. Serum NSE was measured at 24 and 48 h. Outcome was measured by neurologic exam 6 months after cardiac arrest with good outcome defined as a Cerebral Performance Category (CPC) of 1 or 2.


RESULTS
In multiple logistic regression analysis, age (odds ratio [OR], 95% confidence interval 1.1 [1.03-1.18]/year), NSE at 48 h (OR 1.1 [1.02-1.26]/microg/l), and increase in NSE levels (OR 7.2 [1.7-31.3]) were predictors of poor outcome, but the OHCA score was not. Cut-off points with 100% specificity in predicting poor outcome were 33microg/l for NSE at 48h (sensitivity 43% [28-60%]) and 6.4microg/l for delta NSE 24-48 h (sensitivity 44% [28-60%]).


CONCLUSIONS
Increase in NSE between 24 and 48h and NSE at 48h is specific but only moderately sensitive markers of 6-month outcome. Outcome prediction at ICU admission using the OHCA score was not possible in this selected patient population.
Oksanen
Tuomas
T
Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Finland. tuomas.oksanen@hus.fi
Tiainen
Marjaana
M
Skrifvars
Markus B
MB
Varpula
Tero
T
Kuitunen
Anne
A
Castrén
Maaret
M
Pettilä
Ville
V
D000367:Age Factors; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009460:Neurologic Examination; D017063:Outcome Assessment, Health Care; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000628:therapy*
D001786:Blood Glucose; D010751:Phosphopyruvate Hydratase